Lecture Vol. 17 Tab E (Pst. SG yrs) May 17, 1990 cover

My Vision for Rural Health in the 1990s
By
C. Everett Koop, MD, ScD
Presented to
The National Rural Health Association
13" National Annual Conference
New Orleans, Louisiana
May 17, 1990

Apparently I’d been asked to give this same talk two years earlier in Washington at the
11" Annual Meeting and was unable to do so, so I opened regretting that and also
acknowledging that I was much better prepared on this occasion than I would have been
previously because in the interim I had walked the lonely roads of Appalachia, had
visited sick children, visited with rural adults, and talked to worried and overwhelmed
health care providers. I had also had seen the face of rural poverty and the growing loss
of the capacity and public confidence in local health care delivery. So, my intellectual
bond had developed into an emotional bond as well. I acknowledged that that emotional
bond was with those present, but also with their constituency and further acknowledged
that I was appalled at the level of need for all human services in rural American, but that
my heart was warmed by the strength, courage, and hope of our rural citizens. I felt that I
now knew in a very personal way what the National Rural Health Association actually
did. Then I gave kudos where they were deserved and was very personal in my
recollection of those who had won awards and accomplished great things in rural health.

At the time of my address, the NRHA was a broad-based organization of nearly 2,000
individuals and an annual diversified budget of $15 million. The political process had
been successfully engaged by a coalition of primary care centers, hospitals, clinicians,
academics, researchers, and community folks.

For those who know little about the formal activities of those interested in rural health,
this is a good beginning, and speaks by chapter and verse, of the efforts that were made in
the years just before this talk to achieve the position and standing that the NRHA had
among health organizations in America.

I then preached to the choir about some of the major rural issues and some of the
immediate action steps that could be taken and from there moved to conclude with some
broader visions of desirable change. Details are poignant and at times sad, but for anyone
knowledgeable about rural health, they will resonate as truth and for those who are trying
to learn something about it even at the level of 1990, it will be an eye opener. My
wanderings through the future included the rural problems and necessary responses to
things such as AIDS, substance abuse, smoking, systems of health care that not only meet
needs, but operate within the constraints of existing resources.

My lecture closed with some very specific suggestions that must make provision for the
future.